Adenotonsillectomy vs Observation for Management of Mild Obstructive Sleep Apnea in Children. (January 2014)

• Record Type: Journal Article
• Authors: Volsky, Peter G.; Woughter, Meghan A.; Beydoun, Hind A.; Derkay, Craig S.; Baldassari, Cristina M.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 150:Number 1(2014:Jan.)
• Page Start: 126
• Page End: 132
• Publication Date: 2014-01
• Subjects: sleep apnea -- obstructive -- tonsillectomy -- adenoidectomy -- child -- quality of life; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813509780
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To determine the impact of adenotonsillectomy vs observation on quality of life (QOL) in children with mild obstructive sleep apnea (OSA). Study Design: Prospective, nonrandomized trial. Setting: Tertiary children's hospital. Subjects and Methods: Sixty-four children (ages 3-16 years) with mild OSA (apnea hypopnea index between 1 and 5 on polysomnogram) completed the study. Caregivers chose between management options of adenotonsillectomy and observation and completed validated QOL instruments (OSA-18 and Children's Health Questionnaire) at baseline, early, and late follow-ups. The primary outcome measure was QOL. Results: Thirty patients chose adenotonsillectomy, while 34 were observed. Total OSA-18 scores at baseline were significantly poorer ( P = .01) in the surgery group (72.3) compared with the observation group (58.5). Four months following surgery, OSA-18 scores improved by 39.1 points over baseline ( P = .0001), while there was no change for the observation group ( P = .69). After 8 months, OSA-18 scores remained improved in the surgery group, and observation group scores improved by 13.4 points over baseline ( P = .005). While OSA-18 scores at the late follow-up visit were poorer in the observation group, the difference was not statistically significant ( P = .05). Six observation patients opted for adenotonsillectomy during the study. Conclusion: Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months. QOL instruments may be useful tools to help providers determine which children with mild OSA may benefit from early intervention.